Presentation Authors: Joshua Aizen*, Sandra Ham, Brittany Adamic, Craig Labbate, Ciro Andolfi, Sarah Faris, Chicago, IL
Introduction: Although perioperative opioid exposure is implicated in the emergent opioid epidemic in the United States, the impact of these prescriptions on long-term use following urologic surgery is unknown. We sought to determine rates of new persistent opioid use among a previously opioid-naive surgical population as compared to a non-surgical cohort.
Methods: We identified adults aged 18 to 64 who underwent any urologic procedure in 2014-2015 using the Truven Health MarketScan database. Patients were excluded if they filled an opioid prescription in the 12 months preceding surgery. For patients who filled an opioid prescription in the immediate post-operative period, prevalence of persistent opioid use was calculated over 90-day intervals in months 4-6, 7-9, and 10-12 following surgery. We compared these rates to those of a 1:3 comorbidity-matched, opioid-naive, non-surgical sample from the general population. The impact of comorbid conditions on persistent opioid use was also analyzed.
Results: In 2014-2015, 80,657 patients met the inclusion criteria. The cohort had a mean age of 44.4Â±10.7 years and was predominantly male (50,139 [62.2%]). All modalities of urologic surgery were associated with increased rates of new persistent opioid use at each follow up interval compared to the control sample (p < 0.0001). Prevalence of persistent opioid use across the discrete time intervals ranged from 4.72-5.27%, 5.52-6.54%, 8.20-8.80% and 3.46-3.80% for abdominal, endoscopic, percutaneous, and scrotal/penile/perineal/vaginal procedures, respectively. In the non-operative cohort, rates of new opioid use ranged from 3.26-3.59%. There were no clear trends over time in any group. Preoperative risk factors independently associated with persistent opioid use included tobacco use (OR 1.33; 95% CI 1.24-1.44), substance use disorders (OR 1.36; 95% CI 1.08-1.69), any mental health, substance, or pain-related diagnoses (â‰¥3 diagnoses: OR 1.89; 95% CI 1.77-2.01), Charlson comorbidity index (â‰¥2: OR 1.29; 95% CI 1.21-1.37), and total initial opioid prescription â‰¥300 morphine milligram equivalents (OR 1.35; 95% CI 1.26-1.45).
Conclusions: A meaningful fraction of previously opioid-naive patients receiving outpatient opioid analgesia following urologic procedures will go on to develop persistent opioid use. The data reinforce a national need amongst urologists to reduce post-operative opioid usage and validate recent efforts to adopt multimodal narcotic-free pathways.
Source of Funding: The University of Chicago Institute for Translational Medicine Core Subsidy Award